HomeMy WebLinkAboutCLE201100057 Review Comments Zoning Clearance 2011-03-21Application for Zon Clearance
CLE # pr
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY �/�
Check # / j Date: /
Receipt # 8trZ 2 qb Staff:
PARCEL INFORMATION . �
Tax Map and Parcel: D7g — /C� /1 � Existing Zoning
Parcel Owner: CM UG -A' F M 7lb Fl- Lf1/A1
Parcel Address: 00 %161'101M Rocity � ��✓ /�e State W, Zip � /v
(include suite or floor)
PRIMARY CONTACT VMt V1 A' �S
Who should we call /write concerning this project?
Address: 0 60 d 6 5 y �
y Zip
@+Fire Phone: ) 10 Ov Cell # —''� Fax # E -mail
APPLICANT INFORMATI N
Check any that apply: Change of ownership Change of usle Change o`f name n New business
Business Name /Type: ��s�y�� /y ✓���'�y —'`"��
Previous Business on this site �� /� ���1� "t % ���� "�
7 ,',0 flq k� L `Gd AM '7 -a- / a C-Al n,) Z: f
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. 1 also certify that the information provided
is true and accurate to the best of in), knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature t (/ �� ~� Printed V V j A "V
APP DVAL INFORMATION
[ Approved as proposed [ ] Approved with conditions [ j Denied
[ ] Backllow prevention device and /or current test data needed for this site. Contact ACSA, 977-4511, xl 17.
[ �Jo physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date : k i C 1
Zoning Official- Date 3zu zzl
Other Official Date
61 . h L
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 1/1/2011 Page 2of3
Intake to complete the following:
Y / N
Is use in LI, 1 -11 or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
V/N
Will there be food preparation?
11• so, give applicant a Health Department form.
Zoning review can not begin ntiI we receive approval from Health
Dept. FAX DATE�%/
Circle the one that applies
Is parcel on private well r public er?
If private well, provide Health Department form,
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that a
Is parcel on septic or ublic sew
Y/N
Will you be putting up a new sign of any land?
Sign permit,
Permit #
If so, obtain proper
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoniniz to complete the followin :
Reviewer to complete the following:
Square footage of Use: �/ L) D
/ N
Permitted us:
Under Section: �L f Z.
Supplementary regulations section:
Parking formula:
boo
Required spaces:
Y/
ltems to be verified in the field:
Inspector:
Date:
Notes: �n1
��t•�n/�� � C 6Wry�S�il� v � U
Viola, ions:
Y/
If so, List:
Proff
Y/
If so, List:
Varian e:
Y/ 1)
If so, List:
SP's:
Y/-
If so, List:
Clearances:
SDP's
Revised 1/1/2011 Page 3 of3
1
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COMMONWEALTH OF VIRGINIA
DEPARTMENT OF HEALTH
CERTIFIES THAT
Expresso Inc.
is hereby granted a permit /license to operate a Fa/! Service Restaurant
by the Albemarle County Health Department in accordance
with the regulations of the Board of Health,
Commonwealth of Virginia.
FACILITY NAME: EXPRESSO ITALIAN ARID BREAKFAST
PHYSICAL ADDRESS: 1 626 Richmond Road
Charlottesville, Virginia 22911
MAILING ADDRESS: P.O. Box 7245
Charlottesville, VA 22906
EXPIRATION DATE: December 31, 2011
CONDITIONS:
Eric Mjers, REHS
Environment! Health Supervisor
Please direct questions or concerns to the
Albemarle County Health Department,
Environmental Health Services, (434).9 72-6219.
This Permit Is NOT TRANSFERABLE From One Individual
or Location to Another.